ebb and flow of the Tidal Model, The

Mental Health Nursing,  Sep 2004  by Hannigan, Ben

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Can nurses use an evidence base and embrace the Tidal Model? Ben Hannigan ponders

Principles are important. Sometimes in mental health nursing we risk losing sight of this, preferring instead to talk up the importance of skills and knowledge alone. As Poppy Buchanan-Barker described in May's edition of Mental Health Nursing, the Tidal Model seeks to reverse this trend. As a values-based approach to mental health care the model places particular stress on the attitudes and beliefs of nurses. As Buchanan-Barker put it: 'Without the mind set, the technology is worthless.' (Buchanan-Barker, 2004).

The Tidal Model's emphasis on values is a welcome one. Dangers also lurk, however. Eloquently presented new ideas can be seductive, and in seizing hold of them we may, sometimes, be tempted to suspend our critical judgement. We are also particularly adept in mental health nursing at turning new ideas into panaceas. Many nurses welcomed the arrival of 'psycho-social interventions' as a mental health 'cure all', and also as an opportunity to carve out new, more specified, roles in practice.

In similar fashion, the Tidal Model, too, may be uncritically received in some quarters as a 'solution' to the complex problems of mental health care provision and the place of 'nursing' within this.

Practitioners and managers wanting to adopt the Tidal Model are likely to face particular challenges. Being a values-based approach to care, the model cannot, presumably, be 'learned' in the way skills-based approaches can. 'Implementing' the Tidal Model involves embracing attitudinal change. Attitudes and beliefs can be hard to budge, however. A mismatch can also exist between espoused values and those which are enacted (Pattison and Pill, 2004). A practice area which boasts laminated printouts of the Tidal Model's Ten Commitments' on its walls is not necessarily an area in which profound shifts in thinking have taken place, and in which new behaviours are being acted out as a consequence.

The Tidal Model's downplaying of the 'technology' of mental health care also sits awkwardly vis-à-vis the contemporary expectation that practice be evidence-based. This is readily acknowledged by Tidal Model proponents, who see the approach as a framework within which many different interventions may be negotiated between practitioner and service user. Whilst no one 'therapy' appears to be preferred over any other, the strategies used by Tidal Model practitioners are intended to reflect a commitment to Ordinariness' and a belief in the value of conversation. This idea of mental health nursing as an interactive process in which techniques are less important than relationships is an honourable one, and many nurses are likely to have sympathy with this position. However, interventions are important, and some seem to 'work' better than others. The clumsy, non-negotiated prescription of 'effective' interventions does not serve people with mental health problems well. But nor should the kind of person-centred nursing which Tidal Model practitioners seek to provide be used as a licence for nurses to ignore the evidence base.

References

Buchanan-Barker P (2004) The Tidal Model: uncommon sense. Mental Health Nursing 24 (3) 640

Pattison S and Pill R (2004) Professions and values: a dynamic relationship. In Pattison S and Pill R (Eds). Values in Professional Practice: Lessons for health, social care and other professionals. Oxford, Radcliffe Medical Press

Ben Hannigan is a senior Lecturer in Mental Health Nursing, Cardiff University

Copyright Community Psychiatric Nurses Association Sep 2004
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